Some Observations on Students (How Instructors View Standardized Training)

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Preface

Teacher Li Yanpeng recently shared some of his thoughts as a mentor, very candidly, which helped me view standardized training from another perspective.

Original Links

https://mp.weixin.qq.com/s/nBmQGdmo5CWrZxcdXIw5rg

https://mp.weixin.qq.com/s/xHo3wdeSuuRh2kw0dSpBUQ

https://mp.weixin.qq.com/s/_RT1OUN4rDmGc79Ml_NBXg

Main Text

Some Observations of Students (Part One)

1. Students’ Physical Exercise Situation: According to my incomplete personal statistics, maybe about 10% of male students and 1% of female students maintain the habit of exercising, or slightly above this ratio. Currently, the obesity rate in our country is rising sharply, with 1 in 6 children overweight or obese, and myopia rates increasing. Cardiovascular and cerebrovascular diseases in adults are becoming more common at younger ages, with more cases of sudden death, myocardial infarction, cerebral infarction, cerebral hemorrhage, hypertension, and diabetes in people in their twenties. The meme and news about “fragile university students” are increasing. The government calls for kindergartens and primary schools to increase outdoor exercise time, demanding 2-3 hours of outdoor activity for kindergartens. The proportion of physical education scores has increased for junior and senior high school students. However, at university and graduate levels, no one seems to pay attention to physical fitness issues. Apart from stalls, fortune-telling, and dating, how many students actually exercise on campus playgrounds is unclear. Zhang Xuefeng said the difference between graduate students and “working dogs” is that working dogs do 996 while graduate students do 007. Now undergraduates, to find a desired mentor, compete more and more fiercely, scheduling activities like clinical rounds themselves. Besides academic allocation of time, students also have to tidy their dormitories and take care of chores. Local students might entrust some laundry or other tasks to their parents, but this still does not save much time. After classes or leaving the department, they have to deal with projects or other matters late into the night, only closing their eyes briefly to squeeze in sleep, then get up the next day to commute and participate in morning reports. If they cannot guarantee sleep, how can they find time to exercise? Only a small number of students squeeze time to exercise. The number of pull-ups among male students has dropped sharply, with news reporting only 1-2 can be done. Female students cannot complete the 800-meter run or faint, not to mention timing issues. Students’ cervical spondylosis problems are relatively prominent. After the pandemic restrictions eased, palpitations and anxiety symptoms have become more apparent, with increased occurrences of fever or pneumonia. Relying on medication cannot solve the root problems. I hope under the existing system, students can take conscious efforts to stand up and move more every day, exercise for half an hour daily, and develop the habit. But this all depends on willpower; reasoning alone is ineffective. Without willpower, one cannot persist in exercising.

2. Sleep Issues: In the whole society, in basic and service industries, adequate sleep is basically not guaranteed. In healthcare, involving night shifts, the risk of sudden death increases by 10%. On one hand, patients are educated to ensure good sleep, on the other, life expectancy is burning away. Students as soon-to-be adults entering society also suffer from fragmented sleep. Some students have insomnia due to depression and require medication to help sleep. Students rotating in departments disrupt the nervous system due to night shifts, causing insomnia and worsening palpitations. If the dormitory is noisy or everyone has different schedules, sleep is also affected.

3. Psychological Issues: This is not only about students; doctors also experience irritability, anxiety, depression, and other problems due to work pressure, life stress, complaints from patients, etc. Students’ pressures may come from academic comparison with dorm mates, classmates, resource competition among peers, interpersonal problems, social isolation, relationship issues, and breakups—all valuable experiences which they must go through. Whether they have been criticized by mentors, can they tolerate it, are they being overburdened and exhausted, or suffering endless hardships. Have they been verbally abused by patients and psychologically collapsed? Have they cried due to patient death or over-empathized with family members? Do they feel alienated due to their original family’s education style, feeling dull, or struggle with parental misunderstanding resulting in drastic rebellion, finding comfort away from home at school? I have experienced these to various degrees. Currently, the depression rate among college students is very high, with some surveys claiming over 50%, but only 0.4% admit to having depression and receiving medication and regular treatment (allegedly). Whether medication is good or not, I am not a psychiatrist; I only hope everyone can detect and identify depression early without prejudice. Some students activate self-protection by cultivating a cold and indifferent aura; I understand this very well as I was once isolated and struggled for many years before letting go. In school, I couldn’t refuse or defend my boundaries and felt pain because my parents only taught me “Just study hard, nothing else matters.” Learning to say “no,” then politely refuse, and later communicating elegantly has been a continuous process for me. Many things need lifelong learning and self-correction, and each age has its own challenges.

Too long, won’t write more.

Some Observations of Students (Part Two)

4. Relationship with Original Family: I thought people born in the 1960s might have more conservative thinking and ways of doing things; now I find that even those born in the 1970s are not necessarily more advanced, not much better than the 60s generation. Parents from each generation have different points of anxiety, and when we become parents, new anxieties appear. The original family has a huge influence on children’s thinking and behavior. Everyone has personality flaws and weaknesses regardless of being teachers or students. What we can do is recognize our flaws and continuously self-correct after entering society. Everyone has shortcomings; some are mild, some serious. No one should feel inferior, only accept their imperfection and face their situation and experiences. No one is inherently superior; if you want to measure, there are students studying in Beijing and also at Harvard. Since the Harvard scandal broke out, I feel there is nothing special about studying at Harvard anymore; corruption is everywhere in the US and Harvard. No matter what, parents love us, though their ways may be unscientific or unreasonable, some plain love, some harmful without awareness, and some not love at all. We need reflection and self-correction, but some parents never reflect or self-correct and cannot grow with their children. Most families love each other; we respect our parents but should not lose independent thinking. From relying on parents to decide for us to making our own decisions takes a long time.

5. Getting Along with Peers: Some students are simple, carefree, and easy-going who don’t mind suffering losses, just want to graduate and work smoothly. Some care a lot about others’ opinions and expend emotional energy daily. Some like to crack jokes but appear insincere or unpleasant. Some have high emotional intelligence, are helpful, tactful, and make people willingly help them. All these types appear in some proportion; I also want to improve my emotional intelligence and be resilient but feel it’s exhausting. As long as your conscience is clear, keep your boundaries and don’t let others bully you. Future workplace life also requires continual effort to improve. For me, interpersonal skills were a major deficiency; my parents only emphasized studying well and avoided dealing with conflicts. I never learned how to handle peer conflicts.

6. Uncertainty About the Future: The employment situation 20 or 10 years ago is vastly different from now for various reasons: enrollment expansion, poor economic situation, job saturation in big cities, etc. Economically, I know little so I won’t comment. About 20 years ago, there was job assignment; 10 years ago, there was a system of fixed positions. Now it’s all about fierce competition—pursuing master’s, PhD, whether to find a job or continue studying, and which city to work in; all require continuous choices and compromises. No one can guarantee what the future holds; one must cross the river by feeling the stones. Thirteen years ago, I applied for jobs blindly, no one to advise me. I sent out resumes randomly. My first salary was 800 RMB, second month 1300, then 1800, 2300, during residency 3000-5000 RMB monthly, living with parents without worrying about rent or food. My parents wholeheartedly supported me during rotations, so I had no income concerns and focused on learning clinical skills happily. My mentors were kind, indulgent to my clumsiness, which impressed me deeply, leading me to firmly believe that hardworking rotations are natural. Now students have to learn both traditional Chinese medicine and Western medicine, write papers and projects, attend clinical rounds, take exams, and suppress various emotions—it’s really tough.

7. Romance and Marriage: In school, early love is discouraged; after graduation, pressure to marry and have children arises for young people. Non-marriage and childfree trends are popular, but now some 40-year-old childfree people start to regret it. Some divorce; some undergo IVF to have children. Good news is not only female medical students find it hard to find partners, women in other industries also struggle to marry before 30. However, many couples marry and have children ahead of their peers, and some divorced early. Don’t envy others on social media; if all conditions are right, who doesn’t want happiness? If conditions are lacking, focus on yourself first, live well, accomplish your goals, build skills steadily, eat well, and master survival skills are most important.

Too long, don’t want to write more.

Some Observations of Students (Part Three)

9. Rotation Performance: No system is perfect. Students complain about the rotation system; teachers complain about the promotion system. Teachers cannot change the rotation system. The amount of subsidy during rotations, whether student ability matches it, and our wisdom cannot solve these issues, neither are we decision makers. I sense students’ difficulties might include:

If the work intensity is very high, involving unequal pay for equal work.

If the work intensity is very low, involving whether the supervisors are responsible or if students are just sent home directly.

If the department emphasizes clinical practice heavily but the student’s mentor emphasizes research, the student is pulled in extremes, unable to balance time.

If the student values clinical practice but cannot publish any papers, questioning whether they can find a job after graduation.

If the student devalues clinical practice and invests great effort in publishing papers, whether pursuing a research career or job hunting, everyone can see the actual situation and I won’t elaborate. This situation is possibly in compliance with the system.

Some few students have strong clinical skills, publish many papers, and speak well, but they are rare. Students indeed should strive to enhance their value to get better jobs during the early stage. But no one can always be the best. Competing hard and striving is admirable. Most of us only need to manage ourselves well, and it’s also okay to take it easy. If the stress is too high and causes physical and mental exhaustion making academic completion impossible, what is the point? After starting work, should we strive for the top? Work is merely a source of income. This is not encouraging taking it easy; strength remains the hard truth.

The rotation manual summarizes study points, but how to execute depends on teachers’ guidance. Students cannot be expected to self-consciously master everything once entering a department; too much instruction on the first day is impossible to absorb.

I observe some students are active, have opinions, and are not afraid of making mistakes; some worry about making mistakes and avoid hands-on tasks; some are indifferent, only reading their books and ignoring teachers’ calls for help; others are talkative, like allocating and directing work but don’t finish tasks themselves.

Here I only represent my personal views. I believe supervisors must first accept that students are not docile lambs or young children. Nowadays, even elementary school children are hard to manage, being more self-centered and individualistic. Perhaps people from our generation feared teachers and parents and believed students must obey teachers unconditionally. Some still think this way. But adults should have their own thoughts; even under life’s pressure, choices are necessary; it’s impossible to be completely stripped of choice. So teachers should realize that students have diverse personalities. If students don’t want to listen to you, and if they violate rules, beyond reporting to management, you have no other means. Why get emotionally involved or upset? Vice versa, students face teachers of all kinds. If a teacher demands too much, some students report to superiors openly; if not, politely refuse. Why hurt yourself and waste energy? Mainly, students do not dare resist authority and only torment themselves.

Therefore, teachers should not feel disrespected in front of many students or feel losing face. There is no good way to make students obey—criticizing, losing temper, punishing have little effect and make teachers look agitated. Instead, students stay calm and indifferent. Teachers feel upset. After many such experiences, I believe if students disrespect teachers, forget it; don’t care or teach them to respect. No need to waste energy, just let each other be. Among other students, those rude to teachers appear disrespectful, not the teachers losing sanity.

For students, they may not understand what makes teachers angry or what mistakes they made to provoke such anger. Some students have cried from grievance; some appear indifferent, whether due to self-protection or genuine apathy, you care, they don’t. Students have mentors and various supervisors, all teachers, deserving respect. They might be busy or encountered disliked teachers. When I rotated, my mentor criticized me, slammed the table, stared at me hatefully, and shouted at me for missing describing a patient’s history in a test order, poking the paper and tearing a hole—leaving a deep impression. Everyone remembers one or two disliked teachers growing up; I don’t want to explore their inner worlds, nor do I want the world filled with love or to reconcile with those teachers. I just want to let go, treat them as strangers once rotation ends. I must accept that I might be the harsh teacher some students dislike because I am not money, and I can’t please everyone. I also shouldn’t take myself too seriously. Previously mentioned, only those properly trained with correct values can be teachers; as long as you don’t overestimate yourself, all will pass. From this, in medical practice, doctors should not treat themselves as saints. Doctor-patient is a simple service and receiving service relationship. Doctors are not nobler, have no right to scold or mock patients. If you think so, you wouldn’t get into verbal fights with patients nor be so affected by patient sarcasm.

Longer than expected. Won’t write more.